Epidurals and Narcotics During Labor - Yes or No?

This is a summary of my own related experiences among my group of pain-and-stress patients and myself with pain controlling pharmaceuticals of the over-the-counter and prescription varieties.

Each individual's experience is unique, including allergic reactions and ill side effects, and should be discussed with a qualified health practitioner before application of any controlled substance(s). A list of links at the end of this article will help you learn more.

Preventive Medicine

In preventive medicine classes, I was studied disease prevention and control, the action of epidemics, the effects of stress in the workplace, ADD/ADHD, violence in America, and emerging methods in space medicine.

Personally, I was able to study anesthetics a little more in depth. Procedures and products change quickly over time in America, and this material covers many of them in the 2000s. Be on the lookout for new and better techniques in future.

During a 40-minute surgery to repair a lower extremity, I received a single-injection epidural anesthetic (Intrathecal Epidural) that worked quite well in its main function. It produced a feeling of my lower body simply disappearing, rather than being numb. It was also relaxing.

Ten minutes before the end of surgery, I felt something like a wave pass over me from foot to head and at the conclusion of the procedure, I took a nap in recovery and my lower body had returned upon awakening. It's as though that portion of my anatomy passed through another dimension damaged and returned corrected.

My experience, however, this is much different from birthing epidurals, in which a common practice is to access the spine and leave a catheter in a space between the spinal cord and the vertebrae to reach the target nerves (Caudal Epidural - a] Local Only or b] Narcotic Only), for multiple administrations or continuous drip of an anesthetic during/after labor.

The Narcotic Only Epidural is also called the Walking Epidural, except that the patient cannot sometimes walk. She can often move around, though, and the hospital will have rules about walking, moving, and eating during labor, so ask.

My particular side action or adverse reaction to anesthetics post any non-dental surgery is nausea and disorientation. I have had two such surgeries only: tonsillectomy and compound (open) fracture reduction. Each time, I experienced some nausea at first and for 30 days thereafter,disorientation and confusion. The experience was like brain damage. Could mothers receiving epidurals experience this phenomenon?

Concerns of Accessing the Spine

1. The spine is accessed. It is always dangerous to access the spine and the patient signs consent forms for this as well as for the entire birthing experience. Some patients might concern themselves with fear of infection, but this is extremely rare. In even rarer instances, the epidural might begin numbing in the wrong direction - up instead of down - and you need to speak up quickly so that standard procedures for countering this can be given as quickly as possible. My only experience with this is with one of my pain patients that had leg surgery; the anesthetist countered the problem quickly and effectively. Another pain control method was used in his case. Spinal Cord Injury is rarely a result of accessing the spine for an epidural, but ask questions about it and make sure you understand the answers.
2. The patient may feel odd with a catheter taped to her back attached to a thin plastic tube connected to a pump, but there should be no pain in this after the initial slight pain of the needle inserted to make way for the small plastic catheter. -- In my case, I had one injection that hurt only slightly and felt some heat as the anesthetic entered. However, some catheter-using patients feel a tingle, some stating that it is rather "electric." That makes sense, since the spinal nerves form a living electrical cord of sorts.
3. Pain control of any sort is subject to individual differences. The numbness can start anywhere form the top of the belly to the lower part of the uterine area and cannot be precisely predicted. The epidural may even not work at all, in which case other pain control methods can be applied.
4. If the legs are numb, then the epidural patent cannot walk and may wish to do so. This can be frustrating. Aside from this, a bladder catheter may be needed to drain off urine due to lack of control int that area and to prevent additional pressure in the region.
5. An epidural medication may possibly slow down labor and also prevent a woman from pushing through a contraction. Help is available from IV medications that promote contractions, including Oxytocin[Pitocin], which is described in Drug Therapy in Nursing, By Diane S. Aschenbrenner, Samantha J. Venable; Page 1166 - 1180.
6. Epidurals may contain only Local Anesthetics: bupivacaine, chloroprocaine, lidocaine or locals in combination with Opiods or Narcotics: fentanyl, sufentanil, or similar and possibly in combination with Others: epinephrine, morphine; clonidine for blood pressure control, its original use; and others [ibid, CH 59.]. Ask your treatment team what specifically you will be receiving. Your body may have a problem with any or all of them. Blood pressure may plummet, headaches or ear ringing occur, or other events may happen [ibid, CH 59].
7. An infant delivered via epidural may have difficulty breast feeding.

• Water Birth International

  “It was absolutely amazing. After getting in the water he was born in 2 hours, not once did I feel the need for any other form of pain relief. Baby was so calm, no crying, he just looked around wide eyed taking everything in.”

• Wolters Kluwer Health - The Birthing Chair

  The effect of delivering in a birth chair on duration of second stage labor, fetal outcome, and maternal blood loss was examined...

The health and medical community needs to be aware of th drug sensitivities and allergies that patients incur. Patients must report any and all drug sensitivities and allergies that they recognize -- One's new health professionals will not automatically know about them and current professionals should be reminded.

A drug sensitivity can be understood as a less severe adverse reaction to a drug than is a drug allergy, which can culminate in such serious reactions as anaphylactic shock and death. Individual differences still occur and you may even be allergic and unaware that this is true.

Narcotic Side Actions

I learned that when one reports a drug allergy in a hospital, staff sometimes do not believe it. Take care not let this happen to you.

I am allergic to codeine. I am allergic to all narcotics.Having reported this in hospital, I received morphine anyway, over protests.

I devloped restlessness and an intense rash that spread up and down the right side of my body (IV entry point: right arm) and itched like nothing I have previosly experienced. I even scratched in my sleep. The rash bled. The examining doctor did not know what the rash was, Morphine was stopped and the rash gone in 24 hours.

If you are sensitive or allergic to narcotics, make enough noise about it so that your medical team listens to you.

Next for me came Oxycodone. They insisted that I take at least one. It gave me a stabbing stomach pain and nausea. I was given a prescription and said I would not use it. I took acetaminophen for pain prevention for a week afterward and then nothing. My advise to you is: If you are allergic to any narcotic, do not take any other narcotic, but talk to your personal health practitioner about this.

Oxytocin as Pitocin (Hormone)

• Can effectively increase contractions in uterus and mammary glands.
• May produce over-contraction in the uterus and harm the infant or mother.
• May produce fluid buildup and resulting intoxication by water, which can be fatal.
• May produce tachycardia (fast heart beat), palpatations, nervousness in the mother.
• May produce depressed respiration and a range of heart rate changes in the infant.
• May result in the other adverse actions: chest pain, breathing problems, confusion, fast or irregular heartbeat, severe headache, irritation at the injection site (MedLine of the National Institutes of Health). Consult MedWatch for up-to-the minute drug news.

Morphine as DepoDur (Narcotic)

• Dozens of possible side effects listed at the site of this embedded link.

Fentanyl as Duragesic (Narcotic)

• May cause breathing to become severely and dangerously decreased.; has been implicated more clearly as a pain patch application,
• May impair physical and mental abilities.
• May cause vomiting, constipation, excessive sweating.
• Has been found in breast milk and may affect the nursing infant.

Licocaine/Xylocaine (a Local)

• May restrict movement to the extent that it required bedrest.
• May result in spinal anesthesia that must be reversed.
• May produce dropping blood pressure in mother or infant.
• May inhibit the ability to push through a contraction.
• Constipation (this is one I experience in dental use, but is very unusual, not even listed as "rare").
• Other side effects, usual and uncommon.

Remember to consult your health care professional before making any decisions about the use of drugs in conception, pregnancy, childbirt, aftercare, and early infant development.

Have a wonderful family if you choose to have children!